HomeMy WebLinkAboutAPPLICATION & RECEIPTS - 12-00368 - 106 E 1st N - Allen Dental Office - SignSign PermitAppficotion
Cily of Rexburg
Phone: 208.359.3020
Fax: 208.359.3022
35 Norrh,".or,tl,, 1 i ^ql^
Bexovrg. p eii io 3 | lc)D,,?l A*w.re4burs.ors
Alr. i.. t , \U[t-{/1 \-'{ L\n(]
Applicant.f nfu r*nation
Fixed Signage
Owner Name
Site Address:T\ 851qfrMaiiineAd&ess: S AAll ? -.-"*X City/State/Zip:/ \-rerephone: QAE) .4ql - 7.[i3& Mobile:
Contractor f nformation
Contractor's Name:
Contractols Address:
#ity/State/lrp:-7.
Electtical / SRecialty, C"?*?".lJ lnformation (For powered or lighted signs)contractor's N*"., !]ffht 5 t- | rcff c* conrracror,s License Number:
Contractor's Address:City/Stxe/Zip:
Contractor's Telephone:
Contractods Signature:
Sign Information
Mobi]e:
Date:
Sign area sq. ft:Sign Height (from ground):
Sign Descriptions:ArciiFor a Sign Permit it is mandatory that you have the following informarion:
2 sets of elevation drawings of a sig & (plotplatr if abplicable)
}.rw'n to scale-with- dimensions r"JE-^ptil consrruction materialsrooungs rt applcable
Engineer stamped if required
FREE STANDING SIGN
o PIot Plan to scale showing:
r a) Building location
a b) Lot size
n c) New sign location
n .l) Dimensions to sign from property lines
n e) Parking lot entrances
o f) Distance of sign from right of way
o g) Ensting Signs locarion & area
o e) Is sign lighted? Yes (must mut $ate eltctical code)(sign mst be in bgal qonefor lightingantl 4pe)
WALL SIGNS
o 1) !q. footage of wall (sign on)
o b) Existing signs & area
o c) New sign & area
o d) Location of sign on wall
#,t;;fiH-ll?jJf:3:::?!1!*,: (**!:o').(:* must be in lesal rynefortshringand srpe)ff:'"lj::'f"'J;"t::;::^:x;ili:,1.T' ''^r','ir;";o";;;T;{:::':;{"":ri::.T:,**An extra $40.00 charge wil b$ applied ro any powered or
Signature of Applicant:
Note: This document is
AUG I 7 2|iI2
C'TY OF REXBURG
See
applcauon Purposes only (the legal sign pemit fom must be signed-by city offrcials before sign is approved)gn Otdinance (no. 1027) at www.rexburg.org fo" r.gil.tioo information.
-lCLAIM FORM
VENDOR #
VENDOR NAME
2nd LINE NAME
ADDRESS
CITY, STATE, ZIP
/) r',i I i-)u tla-r.z llltt.t-'-- DATE ? liZ l.t c. | 3
DH APPROVAL
CC APPROVAL
CITY OF
REXBIIRG
Ame rica\ Family Co mmunity
DESCRIPTION ACCT#ACCT DESCRIPTION AMOUNT
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CLAIMANT OR HIS AGENT SIGN HERE
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Transaction taken by: mary
City of Rexburg
35 Northlst East
Rexburg, lD 83440
208-359-3020
46 Dnl, Printer
ro Ltry of Rexburg. Date:Og/i7-Tran"""tion
Mastercard - XXXX-XXXX-XXXX484S
Status: Successful
t2012 - 11:37:06 AM
Reference #Amt per ltem I ltems Total AmtMISCELLANEOUS - GENEML $165.00 1 st65.0a
tl
Billing Information
JAMES ALLEN
,83440
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Billing Information
JAMES ALLEN
,83440
I
Iffil
Site Secured by - Starfield Technologies Inc.
Page 1 ofl
City of Rexburg (10006)
Transaction
tffij I 4tlt Col,printer d l -printerror**t s j
to City of
Transaction Number: 1 94{ti67gpTMastercard - XXXX-XXXX-XXXX4B4S
Status: Refunded - Refunded
TOTAL:
Transaction taken by: marianna
Security I Contact Us I privacy policy
O Copyfight 2003 - 201 3 Xpress Bilt pay LLC
https://www.xpressbillpay.com/common/trans details.php?trans id:MjEzNDkOM ze%3D 3/lgl20l3
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il' Transaction detail for payment to City
Billing lnformation
JAMES ALLEN
,83440
t
City af Rexburg I35 Northist East iRexburg, lD 83440 t208-35s-3020 II
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Transaction taken by: mary-*-ffiilffiil
f ryTfl !sgv-qg"ry"e' g_qFv.*ryy,xp:se:!!!!psy.gag_.
__c":gyrqll g x"p::*-.eitl luy 2012 -nrr nilnts nesereo
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:o Lrty 0f Rexburg.
Transaction Number: 1 65SS4g7pTMastercard - XXXX-XXXX-XXXX{B4S
Status: Successfu{
Date:0811712012 - 11:37:06 AM
uescnpuon Reference #Amt per ltem # ltems Total Amt
IVIIDUtr,LLANEUUS - GENERAL $165.00 1 s165.AArtrnMl
8/t7t20r2https : //www. xpressbillpay. com/common/paymentlrocess.php
*.-l.S,yBq citv or Rexburg
Department of Community Development Receipt Number: 124472
35 North lst East / Rexburg, lD. 83440
Phone (208) 359-3020 | Fax(208)359-3022
RPRRXBl034 SignDeposit
RPRRXB1034 Sign Permit
RPRRXBl034 Permit - Electrical
$75.00
s25.00
$65.00
$165.00
CREDIT CARD N/A $ 165.00
Total:$165.00
genpmtneceipts Page 1 of 1